Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 4704284839NSA18929 | MI |
NPI | 1366921520 |
---|---|
Provider Name | Nicholas Badgley |
First Address | Royal Oak, MI 48067-1569 |
Second Address | Kalamazoo, MI 49048-1666 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2018 |
Last Update Date | 08/08/2018 |